SUCCESSFUL PAIN RELIEF BY MOTOR CORTEX STIMULATION FOR EXTENSIVE THALAMIC PAIN : CASE REPORT

Thalamic pain is known as the most difficult pain syndrome to treat. This paper describes our case treated successfully by motor cortex stimulation for extensive thalamic pain. A 59-year-old man with left thalamic pain was readmitted two years after an episode of right thalamic hemorrhage. He complained of tearing pain in the left eye, burning pain in the left upper and lower extremities, and chest pain. After one week of test stimulation, permanent implantation using two electrode arrays to include the area of the lower extremity was done. Excellent pain relief has been sustained for 10 months

POSTOPERATIVE VASOSPASM IN PITUITARY ADENOMA WITH PITUITARY APOPLEXY

A patient who developed complications relating to intracranial arterial vasospasm following transcranial removal of a pituitary adenoma with pituitary apoplexy is reported. A 23-year-old female was admitted because of headache. Computed tomography (CT) and magnetic resonance (MR) imaging revealed a pituitary adenoma with suprasellar extension and pituitary apoplexy and sinusitis in the right maxillary and ethmoid sinuses. A transcranial approach was selected because of active sinusitis. A large, pink intra- and suprasellar neoplasm and intratumoral clot were removed smoothly. Postoperatively, the patient remained stuporous and showed right hemiplegia. Angiography demonstrated stenosis of the left internal carotid artery and severe spasm of perforating arteries from the left middle cerebral artery. Large pituitary adenoma with pituitary apoplexy requires careful perioperative management, with particular attention paid to the surgical approach and procedures

Rational Choice Hypothesis as X-point of Utility Function and Norm Function

Towards the realization of a sustainable, fair and inclusive society, we proposed a novel decision-making model that incorporates social norms in a rational choice model from the standpoints of deontology and utilitarianism. We proposed a hypothesis that interprets choice of action as the X-point for individual utility function that increases with actions and social norm function that decreases with actions. This hypothesis is based on humans psychologically balancing the value of utility and norms in selecting actions. Using the hypothesis and approximation, we were able to isolate and infer utility function and norm function from real-world measurement data of actions on environmental conditions and elucidate the interaction between the both functions that led from current status to target actions. As examples of collective data that aggregate decision-making of individuals, we looked at the changes in power usage before and after the Great East Japan Earthquake and the correlation between national GDP and CO2 emission in different countries. The first example showed that the perceived benefits of power (i.e., utility of power usage) was stronger than the power usage restrictions imposed by norms after the earthquake, contrary to our expectation. The second example showed that a reduction of CO2 emission in each country was not related to utility derived from GDP but to norms related to CO2 emission. Going forward, we will apply this new X-point model to actual social practices involving normative problems, and design the approaches for the diagnosis, prognosis and intervention of social systems by IT systems.Comment: 15 pages, 13 figures. Published online at http://redfame.com/journal/index.php/aef/article/view/4890 . Related to arXiv:2002.0903

Sustainability and Fairness Simulations Based on Decision-Making Model of Utility Function and Norm Function

We introduced a decision-making model based on value functions that included individualistic utility function and socio-constructivistic norm function and proposed a norm-fostering process that recursively updates norm function through mutual recognition between the self and others. As an example, we looked at the resource-sharing problem typical of economic activities and assumed the distribution of individual actions to define the (1) norm function fostered through mutual comparison of value/action ratio based on the equity theory (progressive tax-like), (2) norm function proportional to resource utilization (proportional tax-like) and (3) fixed norm function independent of resource utilization (fixed tax-like). By carrying out numerical simulation, we showed that the progressive tax-like norm function (i) does not increase disparity for the distribution of the actions, unlike the other norm functions, and (ii) has high resource productivity and low Gini coefficient. Therefore the progressive tax-like norm function has the highest sustainability and fairness

Essential role of gastric gland mucin in preventing gastric cancer in mice

信州大学博士（医学）・学位論文・平成24年3月31日授与（甲第916号）・唐澤文寿Gastric gland mucin secreted from the lower portion of the gastric mucosa contains unique O-linked oligosaccharides (O-glycans) having terminal alpha 1,4-linked N-acetylglucosamine residues (alpha GlcNAc). Previously, we identified human alpha 1,4-N-acetylglucosaminyltransferase (alpha 4GnT), which is responsible for the O-glycan biosynthesis and characterized alpha GlcNAc function in suppressing Helicobacter pylori in vitro. In the present study, we engineered A4gnt(-/-) mice to better understand its role in vivo. A4gnt(-/-) mice showed complete lack of alpha GlcNAc expression in gastric gland mucin. Surprisingly, all the mutant mice developed gastric adenocarcinoma through a hyperplasia-dysplasia-carcinoma sequence in the absence of H. pylori infection. Microarray and quantitative RT-PCR analysis revealed upregulation of genes encoding inflammatory chemokine ligands, proinflammatory cytokines, and growth factors, such as Ccl2, Il-11, and Hgf in the gastric mucosa of A4gnt(-/-) mice. Further supporting an important role for this O-glycan in cancer progression, we also observed significantly reduced alpha GlcNAc in human gastric adenocarcinoma and adenoma. Our results demonstrate that the absence of alpha GlcNAc triggers gastric tumorigenesis through inflammation-associated pathways in vivo. Thus, alpha GlcNAc-terminated gastric mucin plays dual roles in preventing gastric cancer by inhibiting H. pylori infection and also suppressing tumor-promoting inflammation.ArticleJOURNAL OF CLINICAL INVESTIGATION. 122(3):923-934 (2012)journal articl

Hypofractionated Stereotactic Radiotherapy (HypoFXSRT) for Stage I Non-small Cell Lung Cancer: Updated Results of 257 Patients in a Japanese Multi-institutional Study

IntroductionHypofractionated stereotactic radiotherapy (HypoFXSRT) has recently been used for the treatment of small lung tumors. We retrospectively analyzed the treatment outcome of HypoFXSRT for stage I non-small cell lung cancer (NSCLC) treated in a Japanese multi-institutional study.MethodsThis is a retrospective study to review 257 patients with stage I NSCLC (median age, 74 years: 164 T1N0M0, 93 T2N0M0) were treated with HypoFXSRT alone at 14 institutions. Stereotactic three-dimensional treatment was performed using noncoplanar dynamic arcs or multiple static ports. A total dose of 18 to 75 Gy at the isocenter was administered in one to 22 fractions. The median calculated biological effective dose (BED) was 111 Gy (range, 57–180 Gy) based on α/β = 10.ResultsDuring follow-up (median, 38 months), pulmonary complications of above grade 2 arose in 14 patients (5.4%). Local progression occurred in 36 patients (14.0%), and the local recurrence rate was 8.4% for a BED of 100 Gy or more compared with 42.9% for less than 100 Gy (p< 0.001). The 5-year overall survival rate of medically operable patients was 70.8% among those treated with a BED of 100 Gy or more compared with 30.2% among those treated with less than 100 Gy (p< 0.05).ConclusionsAlthough this is a retrospective study, HypoFXSRT with a BED of less than 180 Gy was almost safe for stage I NSCLC, and the local control and overall survival rates in 5 years with a BED of 100 Gy or more were superior to the reported results for conventional radiotherapy. For all treatment methods and schedules, the local control and survival rates were better with a BED of 100 Gy or more compared with less than 100 Gy. HypoFXSRT is feasible for curative treatment of patients with stage I NSCLC

Stereotactic body radiation therapy for primary liver tumors with adverse factors

Aim: To test the efficacy and safety of liver stereotactic body radiation therapy (SBRT) in patients who harbor adverse factors.Methods: We retrospectively evaluated the outcomes of liver SBRT in a single cancer center. We invented criteria consisting of two physical factors and two tumor factors to measure the treatment difficulty in each case. The clinical outcomes and toxicity were evaluated by stratification of the harboring factors.Results: A total of 24 (23 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma) patients were eligible for this study, with a median follow-up duration of 18 months. Of all eligible patients, 21 patients (88%) had one or more factors. The local control, progression-free survival, and overall survival rates for all patients at 2 years were 89%, 42%, and 76% respectively. In the patients with physical and tumor adverse factors, local control/progression-free survival/overall survival rates at 2 years were 100%/42%/69% and 80%/23%/78%, respectively. The subgroup of 11 patients with 2 or more factors showed comparable local control rate at 2 years to the subgroup of 13 patients with 0 to 1 factors (100% vs. 86%, P = 0.59). One patient (4.2%) experienced a decline in the Child-Pugh score by 2 points at 3 months after the treatment. Grade 2 to 3 gastrointestinal toxicity was observed in three patients.Conclusion: SBRT showed a high local control rate with acceptable toxicity for the group of liver cancer patients harboring both physical and tumor adverse factors as long as conducted following patient selection and dose constraints that were used in this study